Bupa Hospital Covers WHAT YOU NEED TO KNOW AT A GLANCE Contents Retail hospital covers at a glance 3 Corporate hospital covers at a glance 18 Visitors hospital covers at a glance 22 New Bupa membership cards 28 Bupa International membership cards 29 Pre-authorisation hospital checks for Bupa International members 31 This guide is for the use of hospital staff and providers only and does not contain all product information. Detailed product information can be found at: www.bupa.com.au/info for retail hospital covers www.bupa.com.au/corporate-info for corporate hospital covers www.bupa.com.au/visitors-info for visitors hospital covers www.bupa.com.au/oshc-info for student hospital covers Please also note this guide is subject to change without notice. 2 Effective APRIL 2014 RETAIL Hospital Covers at a Glance This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice. Hospital Cover Active Saver (packaged) Advantage Hospital $1,000 Excess & Hospital Value $1,000 Excess* ON SALE Product off SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees — only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation. Public Hospitals: For Accidents requiring urgent medical attention and the services listed below shared room benefit plus a fixed benefit for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefits plus a fixed benefit for a private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Inclusions: •Knee arthroscopy and meniscectomy procedures •Appendicitis •Removal of tonsils and adenoids •Dental surgery •Minor gynaecological surgery (not including laparoscopy) Excess N/A $1000 per hospital admission (including same day and public hospital admissions). Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment $100 a day (including same day and public hospital admissions), up to a maximum of $500 per hospital stay. N/A The co-payment does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The co-payment will apply for all overnight and day services in a public hospital. MINIMUM Benefits (Share room minimum benefits) Exclusions (No benefits apply) Waiting Periods For the duration of this cover: For the duration of this cover: •All services other than the services listed above and exclusions pay minimum benefits •Surgical podiatry procedures •Surgical podiatry procedures For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] *Hospital Value $1000 Excess was renamed Advantage Hospital $1000 Excess effective 1 April 2012. 3 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Excess BUDGET FAMILY COVER (packaged) BUDGET HOSPITAL & HOSPITAL SELECT VALUE* $250 & $500 EXCESS ON SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit for a private overnight room. Private room benefit not applicable for minimum benefits services. Nil benefit for excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit for a private overnight room. Private room benefit not applicable for minimum benefits services. Nil benefit for excluded services. $250 or $500 per hospital admission (including same day and public admissions). $250 or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult when amount has been met in full. Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment MINIMUM Benefits (Share room minimum benefits) The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. N/A N/A For the duration of this cover: For the duration of this cover: • Pregnancy (including childbirth) •Pregnancy (including childbirth) • IVF and assisted reproductive services •IVF and assisted reproductive services • Cataract and eye lens procedures •Cataract and eye lens procedures • Hip and knee replacements including arthroplasty, revisions and resurfacing procedures •Hip and knee replacements including arthroplasty, revisions and resurfacing procedures • Dialysis for chronic renal failure •Dialysis for chronic renal failure # • Psychiatric services •Psychiatric services • Surgical podiatry procedures •Gastric banding and all obesity related treatment •Surgical podiatry procedures # EXCLUSIONS (No benefits apply) Waiting Periods ialysis only attracts minimum benefits if the member joined on or after D 1 April 2006 For the duration of this cover: For the duration of this cover: • Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment • Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required • 2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services • 12 months pre-existing condition •12 months pre-existing condition • 12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) • N o waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] *Hospital Select Value $250 & $500 Excess was renamed Budget Hospital $250 & $500 Excess effective 1 April delete. 4 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Budget Hospital & Hospital Select Value $1,000 Excess* Choices (PACKAGED) off SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Shared room minimum benefits plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees — only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation. Public Hospitals: For Accidents requiring urgent medical attention and the services listed below shared room benefit plus a fixed benefit for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Inclusions: •Knee arthroscopy and meniscectomy procedures •Appendicitis •Removal of tonsils and adenoids •Dental surgery •Ankle arthroscopy and ankle ligament repair •Shoulder arthroscopy and selected minor shoulder procedures Excess $1000 per hospital admission (including same day and public admissions). $250 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. Capped each calendar year at once per person, twice per couples membership when amount has been met in full. The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment MINIMUM Benefits (Share room minimum benefits) Exclusions (No benefits apply) The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. N/A N/A For the duration of this cover: For the duration of this cover: •Psychiatric services •Surgical podiatry procedures •All services other than the services listed above and exclusions pay minimum benefits For the duration of this cover: For the duration of this cover: •Cardiac and cardiac-related services •Cardiac and cardiac-related services •Pregnancy (including childbirth) •Pregnancy (including childbirth) •Surgical podiatry procedures •IVF and assisted reproductive services •IVF and assisted reproductive services •Cataract and eye lens procedures •Cataract and eye lens procedures •All joint replacements including arthroplasty revisions and resurfacing procedures •All joint replacements including arthroplasty, revisions and resurfacing procedures •Dialysis for chronic renal failure # •Dialysis for chronic renal failure •Gastric banding and all obesity related treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required # Waiting Periods Dialysis is an exclusion if the member joined on or after 1 April 2006 •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] *Hospital Select Value $1000 Excess was renamed Budget Hospital $1000 Excess effective 1 April 2012. 5 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Established Family cover Family Essentials ON SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Members First & Network Hospitals Children: Cover for hospital accommodation, theatre fees at shared room (ie: no private add on payable) and ICU, except for minimum benefit or excluded services. Nil benefit for excluded services. Adults: For accidents requiring urgent medical attention full cover for hospital accommodation at shared room (ie no private room add on payable) and theatre fees except for minimum benefit or excluded services. All other services that are not excluded receive share room minimum benefits only. Nil benefit for excluded services. Public Hospitals: All services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Excess $250 or $500 per hospital admission (including same day and public admissions). N/A Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment MINIMUM Benefits (Share room minimum benefits) N/A N/A For the duration of this cover: For the duration of this cover: • Pregnancy (including childbirth) •Surgical podiatry procedures • IVF and assisted reproductive services • Cataract and eye lens procedures • Surgical podiatry procedures Exclusions (No benefits apply) Waiting Periods For the duration of this cover: For the duration of this cover: • Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment • Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required • 2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services • 12 months pre-existing condition •12 months pre-existing condition • 12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) • N o waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 6 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Excess Family First (PACKAGED) Growing FAMILY COVER (packaged) OFF SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. $250, $500, or $1000 per hospital admission (including same day and public admissions). $250 or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. N/A A co-payment does not apply to any child dependant covered on the membership. The co-payment does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The co-payment will apply for all overnight and day services in a public hospital. MINIMUM Benefits (Share room minimum benefits) For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures • IVF and assisted reproductive services • Cataract and eye lens procedures • Hip and knee replacements including arthroplasty, revisions and resurfacing procedures • Dialysis for chronic renal failure • Surgical podiatry procedures Exclusions (No benefits apply) Waiting Periods For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment • Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required • Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services • 2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition • 12 months pre-existing condition •12 months pregnancy (including childbirth) • 12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) • N o waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 7 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Excess Co-Payment HealthSmart Diamond (PACKAGED) HealthSmart Gold (PACKAGED) OFF SALE Product OFF SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. $250, $500, or $1000 per hospital admission (including same day and public admissions). $250, $500, or $1000 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couple or family membership when amount has been met in full. Capped each calendar year at once per person, twice per couple or family membership when amount has been met in full. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess will apply for all overnight and day services in a public hospital. $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. N/A The co-payment does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The co-payment will apply for all overnight and day services in a public hospital. MINIMUM Benefits For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Surgical podiatry procedures Exclusions For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) (Share room minimum benefits) (No benefits apply) Waiting Periods Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 8 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Excess HealthSmart (packaged) Hospital Cover with Excess Bonus* OFF SALE Product OFF SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. $250, $500, or $1000 per hospital admission (including same day and public admissions). $250 per hospital admission from 1 April 2013 (including same day and public admissions). Capped each calendar year at once per person, twice per couples membership when amount is met in full. From 1 April 2013 capped each calendar year at once per adult when amount is met in full. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The excess will not apply to any child dependant covered on the membership. Excess will apply for all overnight and day services in a public hospital. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess Bonus: One excess-free overnight or same-day admission for single or single parent membership and two for a couple or family membership per calendar year (ceasing 1 June 2013). However, existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any additional excess. Co-Payment MINIMUM Benefits (Share room minimum benefits) Exclusions (No benefits apply) N/A N/A For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Surgical podiatry procedures •Gastric banding and all obesity related services (applies from 1 June 2014) For the duration of this cover: For the duration of this cover: •Pregnancy (including childbirth) •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •IVF and assisted reproductive services •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required Waiting Periods •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] *H ospital Cover with Excess Bonus was renamed Top Hospital Cover $250 Excess from 1 June 2013. 9 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Excess Hospital Cover with Excess Bonus Plus Hospital Cover with excess* (LEVEL 4) OFF SALE Product OFF SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. $200 per hospital admission (including same day and public admissions). $400 per hospital admission (including same day and public admissions). From 1 April 2013 capped each calendar year at once per adult when amount is met in full. From 1 April 2013 capped each calendar year at once per adult when amount is met in full. The excess will not apply to any child dependant covered on the membership. The excess will not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess will apply for all overnight and day services in a public hospital. Excess Bonus: One excess-free overnight or same-day admission for single or single parent membership and two for a family membership per calendar year (ceasing 1 June 2013). However, existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any additional excess. Co-Payment N/A N/A MINIMUM Benefits For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Surgical podiatry procedures Exclusions For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) (Share room minimum benefits) (No benefits apply) Waiting Periods Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] *Hospital Cover with Excess Level 5 was renamed Top Hospital $500 Excess effective 1 April 2013. Refer to Top Hospital Cover for details. 10 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Excess Co-Payment Hospital ECONOMY COVER Hospital ECONOMY Cover with Excess Bonus OFF SALE Product OFF SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. $400 per hospital admission (including same day and public admissions). $400 per hospital admission (including same day and public admissions). From 1 April 2013 capped each calendar year at once per adult when amount is met in full. From 1 April 2013 capped each calendar year at once per adult when amount is met in full. The excess will not apply to any child dependant covered on the membership. The excess will not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess will apply for all overnight and day services in a public hospital. Excess Bonus Dollars: Existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any excess. Excess Bonus Dollars: Existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any excess. $40 a day (including same day and public admissions), up to a maximum of $200 per hospital stay. N/A From 1 April 2013 the co-payment will not apply to any child dependant covered on the membership. The co-payment does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The co-payment will apply for all overnight and day services in a public hospital MINIMUM Benefits For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Surgical podiatry procedures Exclusions For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) (Share room minimum benefits) (No benefits apply) Waiting Periods Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 11 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Excess Hospital Saver* Hospital Saver Plus* OFF SALE Product OFF SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. $500 per hospital admission (including same day and public admissions). Hospital Saver Plus had 5 levels to choose from: Capped each calendar year at once per person, twice per couple or family membership when met in full. •Level 2 – (refer to Standard Hospital $250) The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. •Nil excess •Level 3 – (refer to Standard Hospital $250) •Level 4 – $400 •Level 5 – (refer to Standard Hospital $500) The excess is paid per hospital admission (including same day and public admissions). From 1 April 2013 capped each calendar year at once per adult when amount is met in full. The excess will not apply to any child dependent covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment MINIMUM Benefits (Share room minimum benefits) N/A N/A For the duration of this cover: For the duration of this cover: •Cataract and eye lens procedures •Cataract and eye lens procedures •Hip and knee replacements including arthroplasty, revisions and resurfacing procedures •Hip and knee replacement including arthroplastry, revisions and resurfacing procedures •Pregnancy (including childbirth) •IVF and assisted reproductive services (from 1 June 2013) # •IVF and assisted reproductive services •Dialysis for chronic renal failure •Psychiatric services •Surgical podiatry procedures •Gastric banding and all obesity related treatment •Dialysis for chronic renal failure •Surgical podiatry procedures Exclusions (No benefits apply) Waiting Periods #T his change does not apply to the Nil Excess level. For all other levels: Members who have served waiting periods will continue to be covered for IVF and assisted reproductive services until 31 December 2013. For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] *H ospital H ospital Hospital Hospital 12 Saver Saver Saver Saver is now Budget Hospital $500 excess. Plus Level 2 was renamed Standard Hospital $250 Excess effective 1 June 2013. Plus Level 5 was renamed Standard Hospital $500 Excess effective 1 April 2013. Plus Level 3 will be renamed Standard Hospital $250 Excess effective 1 April 2014. Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover LIVE WELL Public Hospital ON SALE PRODUCT (from 1 April 2013) OFF SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. All hospitals: Minimum Benefits for shared room accommodation only. Excluded Services receive no benefits. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Excess Nil, $250 and $500 options. Applies per hospital admission including same day and public admissions. N/A Capped each calendar year at once per person, twice per couples membership when amount has been paid in full. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment MINIMUM Benefits (Share room minimum benefits) N/A N/A For the duration of this cover: For the duration of this cover: • Pregnancy (including childbirth) •All services when in private hospitals • IVF and assisted reproductive services •Surgical podiatry procedures • Dialysis for chronic renal failure • Gastric banding and all obesity related treatment • Surgical podiatry procedures Exclusions (No benefits apply) Waiting Periods For the duration of this cover: For the duration of this cover: • Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment • Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required • 2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services • 12 months pre-existing condition •12 months pre-existing condition • 12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) • N o waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 13 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Singles Choice Saver (packaged) Standard HOSPITAL & HOSPITAL SELECT PLUS $250 & $500 EXCESS* OFF SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees — only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for share room accommodation. Public Hospitals: For Accidents requiring urgent medical attention and the services listed below shared room benefit plus a fixed benefit for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Inclusions: • Knee arthroscopy and meniscectomy procedures • Appendicitis • Removal of tonsils and adenoids • Dental surgery • Minor gynaecological surgery (not including laparoscopy) Excess N/A $250 or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult when amount is met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment MINIMUM Benefits (Share room minimum benefits) N/A N/A For the duration of this cover: For the duration of this cover: •All services other than the services listed above and exclusions pay minimum benefits •Cataract and eye lens procedures •Surgical podiatry procedures •Hip and knee replacements including arthroplasty, revisions and resurfacing procedures •Dialysis for chronic renal failure # •IVF and assisted reproductive services •Surgical podiatry procedures # Exclusions (No benefits apply) Waiting Periods ialysis only attracts minimum benefits if the member joined on or after D 1 April 2006 For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] *H ospital Hospital Hospital Hospital 14 Select Plus $250 & $500 Excess was renamed Standard Hospital $250 & $500 Excess effective 1 April 2013. Saver Plus Level 2 was renamed Standard Hospital $250 Excess effective 1 June 2013. Saver Plus Level 5 was renamed Standard Hospital $500 Excess effective 1 April 2013. Saver Plus Level 3 will be renamed Standard Hospital $250 Excess effective 1 April 2014. Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Excess Standard Hospital $1,000 EXCESS & HOSPITAL SELECT PLUS $1000 EXCESS* Start n Save OFF SALE Product OFF SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. Public Hospitals: Shared room Minimum Benefit plus a fixed benefit per day for private overnight room. Private room benefit not applicable for minimum benefit services. Nil benefit for excluded services. $1000 per hospital admission (including same day and public admissions). $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. The excess does not apply to any child dependant on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess Bonus Dollars: Existing dollar amounts under the previous Excess Bonus dollar scheme may be used towards any additional excess. Co-Payment N/A $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. The co-payment does not apply to any child dependant on the membership. The co-payment does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The co-payment will apply for all overnight and day services in a public hospital MINIMUM Benefits For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Surgical podiatry procedures Exclusions For the duration of this cover: For the duration of this cover: •Cataract and eye lens procedures •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment (Share room minimum benefits) (No benefits apply) •All joint replacements including arthroplasty, revisions and resurfacing procedures •IVF and assisted reproductive services •Dialysis for chronic renal failure •Cosmetic surgery that is not clinically required # •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required # Waiting Periods ialysis only attracts minimum benefits if the member joined on or after D 1 April 2006 •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] *Hospital Select Plus $1000 Excess was renamed Standard Hospital $1000 Excess effective 1 April 2012. 15 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Top Hospital Cover (NOW Incorporating Advantage Hospital, Hospital Plus, Hospital Value, HOSPITAL SUPER PLUS, HOSPITAL COVER EXCESS LEVEL 5 & Premium Hospital)* Ultimate Health Cover (packaged) ON SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. In addition this product covers laser eye procedures used to adjust the eyeball to correct sight (excludes laser procedures involving lens implants). Only at Bupa approved centres. Ultimate Health Cover members charged a fixed daily fee by any of our contracted fixed fee hospitals will be reimbursed or have the fee paid directly to the hospital. Excess For the excess options: $250 or $500 per hospital admission (including same day and public admissions). N/A Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment For the co-payment option: $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. N/A The co-payment does not apply to child dependants on the membership. The co-payment does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The co-payment will apply for all overnight and day services in a public hospital MINIMUM Benefits For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Surgical podiatry procedures Exclusions For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •1 year laser eye correction (excludes lens implant for eye correction) (Share room minimum benefits) (No benefits apply) Waiting Periods •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] Ultimate members attending a fixed fee service will have this charge paid directly to the hospital or reimbursed. * Top Hospital Cover has 4 levels: • Top Hospital Cover — no excess or co-payment (includes previously named Premium Hospital & Hospital Super Plus) • Top Hospital Cover with Co-payment (includes previously named Advantage Hospital with Co-payment & Hospital Plus) • Top Hospital Cover with $250 Excess (includes previously named Advantage Hospital $250 Excess, Hospital Value $250 Excess and Hospital Cover with Excess Bonus) • Top Hospital Cover with $500 Excess (includes previously named Advantage Hospital $500 Excess, Hospital Value $500 Excess and Hospital Cover with Excess Level 5) 16 Effective APRIL 2014 RETAIL Hospital Covers at a Glance Hospital Cover Young Singles/Couples Choice (packaged) Young Singles/COUPLES Saver (packaged) ON SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees — only for accidents requiring urgent medical attention and the services included below. All other services that are not excluded receive Minimum Benefits for shared room accommodation. Public Hospitals: For Accidents requiring urgent medical attention and the services listed below shared room benefit plus a fixed benefit for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Inclusions: • Knee arthroscopy and meniscectomy procedures • Appendicitis • Removal of tonsils and adenoids • Dental surgery • Minor gynaecological surgery (not including laparoscopy) Excess Co-Payment MINIMUM Benefits (Share room minimum benefits) N/A N/A $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. $50 a day (including same day and public admissions), up to a maximum of $250 per hospital stay. The co-payment does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The co-payment does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The co-payment will apply for all overnight and day services in a public hospital. The co-payment will apply for all overnight and day services in a public hospital. For the duration of this cover: For the duration of this cover: •Cardiac and cardiac-related services •All services other than the services listed above and exclusions pay minimum benefits •Pregnancy (including childbirth) •IVF and assisted reproductive services •Surgical podiatry procedures •Cataract and eye lens procedures •Hip and knee replacements including arthroplasty, revisions and resurfacing procedures •Psychiatric services •Gastric banding and all obesity related treatment •Dialysis for chronic renal failure •Rehabilitation services •Surgical podiatry procedures Exclusions (No benefits apply) Waiting Periods For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 17 Effective APRIL 2014 CORPORATE Hospital Covers at a Glance This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice. Hospital Cover Excess Co-Payment MINIMUM Benefits (Share room minimum benefits) Corporate Hospital Cover Corporate Hospital Intermediate ON SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. •Level 1 – Nil Excess •Level 1 – Nil Excess •Level 2 – $250 per hospital admission for adults •Level 2 – $250 per hospital admission for adults •Level 3 – $500 per hospital admission for adults •Level 3 – $500 per hospital admission for adults Excess payable on same day and public admissions. Excess payable on same day and public admissions. Capped each calendar year at once per adult when amount has been met in full. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess will apply for all overnight and day services in a public hospital. N/A N/A For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Hip and knee replacement including revisions and resurfacing procedures •Cataract and eye lens procedures •Surgical podiatry procedures •IVF & assisted reproductive services (effective from 1st June 2014) # # Exclusions (No benefits apply) Waiting Periods embers who have served waiting periods will continue to be covered for M IVF and assisted reproductive services until 31 December 2014. Conditions apply, contact Bupa for eligibility. For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 18 Effective APRIL 2014 CORPORATE Hospital Covers at a Glance Hospital Cover Excess Co-Payment MINIMUM Benefits (Share room minimum benefits) Corporate Hospital Saver Corporate Hospital Top ON SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. •Level 1 – Nil Excess •Level 1 – Nil Excess •Level 2 – $250 per hospital admission •Level 2 – $250 per hospital admission for adults •Level 3 – $500 per hospital admission •Level 3 – $500 per hospital admission for adults Excess payable on same day and public admissions. Excess payable on same day and public admissions. Capped each calendar year at once per person, twice per couples or family membership when amount has been met in full. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess will apply for all overnight and day services in a public hospital. N/A N/A For the duration of this cover: For the duration of this cover: •Psychiatric services •Surgical podiatry procedures •Pregnancy (including childbirth) •IVF and assisted reproductive services •Cataract and eye lens procedures •Hip and knee replacements including revisions and resurfacing procedures •Gastric banding & all obesity related treatment (effective 1 June 2014) •Surgical podiatry procedures Exclusions (No benefits apply) Waiting Periods For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 19 Effective APRIL 2014 CORPORATE Hospital Covers at a Glance Hospital Cover Excess HealthLink Advantage/ Classic/Essentials Plus HealthLink Hospital ON SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees for services that are not Minimum Benefit or Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. $0, $250, $500, or $1000 capped at once per person, twice per membership per calendar year when amount has been met in full. $0, $250, $500, or $1000 capped at once per person, twice per membership per calendar year when amount has been met in full. Excess payable on same day and public admissions. Excess payable on same day and public admissions. No excess for any child dependant on HealthLink Advantage only. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess will apply for all overnight and day services in a public hospital. Excess Bonus N/A N/A Co-Payment N/A N/A For the first 24 months: For the first 24 months: •Hip and knee replacement including revisions and resurfacing procedures (except where they are required as a result of an accident which occurs after the cover commenced) •Hip and knee replacement including revisions and resurfacing procedures (except where they are required as a result of an accident which occurs after the cover commenced) •Cataract and eye lens procedures •Cataract and eye lens procedures •Dialysis for chronic renal failure •Dialysis for chronic renal failure (Excess Waiver) MINIMUM Benefits (Share room minimum benefits) •IVF and assisted reproductive services •IVF and assisted reproductive services •Bone marrow transplants •Bone marrow transplants •All psychiatric conditions (except eating disorders and post natal depression) •All psychiatric conditions (except eating disorders and post natal depression) •Surgical podiatry procedures For the duration of this cover: •Surgical podiatry procedures Exclusions (No benefits apply) Waiting Periods For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 20 Effective APRIL 2014 CORPORATE Hospital Covers at a Glance Hospital Cover MINING AND RESOURCES HEALTH COVER Ultimate CORPORATE Health Cover (Package) ON SALE Product ON SALE Product Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Members First & Network Hospitals: Cover for hospital accommodation (including private room) and theatre fees except for Minimum Benefit and Excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. Public Hospitals: Shared room minimum benefit plus a fixed benefit per day for a private overnight room. All other services that are not excluded receive shared room minimum benefits. Nil benefit for excluded services. In addition this product covers laser eye procedures to correct sight (excludes laser procedures involving lens implants). Only at Bupa approved centres. Ultimate Corporate Health Cover members charged a fixed daily fee by any of our contracted fixed fee hospitals will be reimbursed or have the fee paid directly to the hospital. Excess •Level 1 – Nil Excess N/A •Level 2 – $250 per hospital admission for adults Excess payable on same day and public admissions. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess Bonus N/A N/A Co-Payment N/A N/A MINIMUM Benefits For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Surgical podiatry procedures Exclusions For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •2 month initial, palliative care, psychiatric and rehabilitation services •2 month initial, palliative care, psychiatric and rehabilitation services •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •12 months laser eye correction (excludes lens implant for eye correction) (Excess Waiver) (Share room minimum benefits) (No benefits apply) Waiting Periods •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 21 Effective APRIL 2014 VISITORS Hospital Covers at a Glance NON-WORKING VISA This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice. Hospital Cover Advantage Visitors Cover MID VISITORS COVER OVERSEAS STUDENT HEALTH COVER/ ADVANTAGE OVERSEAS STUDENT HEALTH COVER ON SALE Product OFF SALE Product ON SALE Product Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Shared room benefits for hospital accommodation in all public hospitals only, except for excluded services. Cover for hospital accommodation in public hospitals, except for excluded and minimum benefit services. Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation in public hospitals, except for excluded and minimum benefit services. Excess N/A N/A N/A Co-Payment N/A N/A N/A For the period specified: For the duration of this cover: For the duration of this cover: •2 years – Cataract and eye lens procedures • Surgical podiatry procedures •Surgical podiatry procedures For the duration of this cover: For the duration of this cover: For the duration of this cover •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment • IVF and assisted reproductive services •IVF and assisted reproductive services • Cataract and eye lens procedures •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment MINIMUM Benefits (Share room benefits) •2 years – Hip and knee replacements including arthroplasty, revisions and resurfacing procedures For the duration of this cover: •Surgical podiatry procedures Exclusions (No benefits apply) •IVF and assisted reproductive services (effective 1 June 2014) # •Cosmetic surgery that is not clinically required # embers who have served waiting periods will M continue to be covered for IVF and assisted reproductive services until 31 December 2014. Conditions apply, contact Bupa for eligibility. • Hip and knee replacements including arthroplasty, revisions and resurfacing procedures • Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required • All cosmetic surgery (including clinically required) • Sterilisation reversal Waiting Periods •12 months pre-existing condition • 12 months pre-existing condition •12 months pregnancy (including childbirth) • 12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) • 12 months psychiatric and rehabilitation • N o waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •2 month pre-existing condition of a psychiatric nature (not applicable to Advantage Overseas Student Health Cover) •12 months for all other pre-existing conditions •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Medical Cover Up to 100% of MBS fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% MBS fee (or the Gap Scheme benefit if you're a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] *Short Stay Education Cover was renamed Short Stay Visitors Cover effective 1 April 2014. 22 Effective APRIL 2014 VISITORS Hospital Covers at a Glance Hospital Cover Overseas Visitors Cover Premium Visitors Cover OFF SALE Product OFF SALE Product Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation in public hospitals, except for excluded and minimum benefit services. Cover for hospital accommodation in public hospitals, except for excluded and minimum benefit services. Excess N/A N/A Co-Payment N/A N/A For the period specified: For the period specified: •12 months – Cardiac and cardiac-related services •12 months – Cardiac and cardiac-related services •12 months – Pregnancy (including childbirth) •12 months – Pregnancy (including childbirth) •2 years – Cataract and eye lens procedures •2 years – Cataract and eye lens procedures •2 years – Hip and knee replacements including arthroplasty, revisions and resurfacing procedures •2 years – Hip and knee replacements including arthroplasty, revisions and resurfacing procedures •2 years – Psychiatric services •2 years – Psychiatric services •2 years – Rehabilitation services •2 years – Rehabilitation services For the duration of this cover: For the duration of this cover: •Cosmetic surgery that is clinically required and is recognised by Medicare •Cosmetic surgery that is clinically required and is recognised by Medicare •Surgical podiatry procedures •Surgical podiatry procedures For the duration of this cover: For the duration of this cover: •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •IVF and assisted reproductive services (effective 1 June 2014) # •IVF and assisted reproductive services (effective 1 June 2014) # •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required MINIMUM Benefits (Share room benefits) EXCLUSIONS (No benefits apply) # Waiting Periods Medical Cover embers who have served waiting periods will continue to be covered for M IVF and assisted reproductive services until 31 December 2014. Conditions apply, contact Bupa for eligibility. # embers who have served waiting periods will continue to be covered for M IVF and assisted reproductive services until 31 December 2014. Conditions apply, contact Bupa for eligibility. •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Up to 100% of MBS fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 23 Effective APRIL 2014 VISITORS Hospital Covers at a Glance Hospital Cover Excess Short Stay VISITORS Cover STANDARD VISITORS COVER Top Visitors Cover ON SALE Product ON SALE Product ON SALE Product Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation in public hospitals, except for excluded and minimum benefit services. Cover for hospital accommodation for public hospitals, except for excluded and minimum benefit services. Cover for hospital accommodation for public hospitals, except for excluded and minimum benefit services. $250 per hospital admission (including same day and public admissions). N/A Nil excess option or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult, when amount has been met in full. Capped each calendar year at once per adult, when amount has been met in full. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. The excess does not apply to any child dependant on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Excess will apply for all overnight and day services in a public hospital. Co-Payment MINIMUM Benefits (Share room benefits) EXCLUSIONS (No benefits apply) N/A N/A N/A For the duration of this cover For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Cardiac and cardiac related services •Surgical podiatry procedures •Surgical podiatry procedures For the duration of this cover For the duration of this cover: For the duration of this cover: •All pre-existing ailments, illnesses or conditions •Pregnancy (including childbirth) •Pregnancy (including childbirth) •Cataract and eye lens procedures •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •IVF and assisted reproductive services •Cataract and eye lens procedures •Hip and knee replacements including arthroplasty, revisions and resurfacing procedures •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •All cosmetic surgery (including clinically required) Waiting Periods •Hip and knee replacements including arthroplasty, revisions and resurfacing procedures •Dialysis for chronic renal failure •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required # embers who have served waiting periods will M continue to be covered for IVF and assisted reproductive services until 31 December 2014. Conditions apply, contact Bupa for eligibility. •All cosmetic surgery (including clinically required) •Sterilisation reversal •12 months pre-existing condition •12 months pre-existing condition •12 months rehabilitation services •12 months psychiatric and rehabilitation •12 months palliative care •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Up to 100% MBS fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 24 •IVF and assisted reproductive services (effective 1 June 2014) # •12 months psychiatric services •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Medical Cover •IVF and assisted reproductive services Effective APRIL 2014 VISITORS Hospital Covers at a Glance WORKING VISA This guide is for the use of hospital staff and providers only and does not contain all product information. Please also note this guide is subject to change without notice. Hospital Cover Classic Visitors Cover CORPORATE OVERSEAS Visitors Cover ESSENTIAL VISITORS COVER/ESSENTIAL PLUS VISITORS COVER off SALE Product OFF SALE Product ON SALE PRODUCT Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation in public hospitals, except for excluded and minimum benefit services. Cover for hospital accommodation in public hospitals, except for excluded and minimum benefit services. Shared room benefits for hospital accommodation in all public hospitals only except for excluded services. Excess N/A N/A N/A Co-Payment N/A N/A N/A For the duration of this cover: For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Surgical podiatry procedures •Pregnancy (including childbirth) MINIMUM Benefits (Share room benefits) EXCLUSIONS (No benefits apply) •Surgical podiatry procedures For the duration of this cover: For the duration of this cover: For the duration of this cover: •IVF and assisted reproductive services •All pre-existing ailments, illnesses and conditions •Outpatient ante and post natal services •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required Waiting Periods •12 months pre-existing condition •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Medical Cover •IVF and assisted reproductive services •Outpatient psychiatric and psychology benefits •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Bone marrow transplants •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •12 months pregnancy (including childbirth) •12 months pre-existing condition •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •IVF and assisted reproductive services •Organ transplants •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. Up to 100% of MBS fee as a hospital outpatient or by a doctor or specialist in private practice anywhere in Australia. Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 25 Effective APRIL 2014 VISITORS Hospital Covers at a Glance Hospital Cover Excess EXECUTIVE Corporate Visitors Cover GOLD VISITORS COVER/PLATINUM VISITORS COVER OFF SALE Product ON SALE Product Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation in public hospitals, except for excluded and minimum benefit services. Cover for hospital accommodation in public hospitals, except for excluded and minimum benefit services. N/A Nil excess option or $500 per hospital admission (including same day and public admissions). Capped each calendar year at once per adult, when amount has been met in full. The excess does not apply to any child dependant covered on the membership. The excess does not apply on admissions for services with a minimum benefit or for approved hospital ambulatory programs or psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. Co-Payment N/A N/A MINIMUM Benefits For the duration of this cover: For the duration of this cover: •Surgical podiatry procedures •Surgical podiatry procedures Exclusions For the duration of this cover: For the duration of this cover: (Share room benefits) (No benefits apply) Waiting Periods Medical Cover •IVF and assisted reproductive services •IVF and assisted reproductive services •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required •12 months pre-existing condition •12 months pre-existing condition •12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. Up to 150% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Up to 150% of MBS fee as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 26 Effective APRIL 2014 VISITORS Hospital Covers at a Glance Hospital Cover SELECT VISITORS COVER Ultimate Corporate Visitors Cover OFF SALE PRODUCT ON SALE Product Share room benefits for hospital accommodation in all public hospitals only, except for excluded services. Cover for hospital accommodation (including private room) and theatre fees in Members First and most Network hospitals except for minimum benefit and excluded services. Cover for hospital accommodation for public hospitals, except for excluded and minimum benefit services. Ultimate Health Cover members will be reimbursed if charged a fixed daily fee by any of our contracted fixed fee hospitals/ services or have the fee paid directly to the hospital. Excess N/A N/A Co-Payment N/A N/A MINIMUM Benefits For the duration of this cover: For the duration of this cover: • Surgical podiatry procedures •Surgical podiatry procedures Exclusions For the duration of this cover: For the duration of this cover: (Share room benefits) (No benefits apply) • IVF and assisted reproductive services •IVF and assisted reproductive services • Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment •Procedures not recognised by Medicare or not approved by the Medical Services Advisory Committee and experimental treatment • Cosmetic surgery that is not clinically required •Cosmetic surgery that is not clinically required • Outpatient medical fees Waiting Periods Medical Cover • 12 months pre-existing condition •12 months pre-existing condition • 12 months pregnancy (including childbirth) •12 months pregnancy (including childbirth) • N o waiting period for accidents sustained after joining (if medical advice sought within 72 hours) •No waiting period for accidents sustained after joining (if medical advice sought within 72 hours) Up to 100% of AMA Schedule fee (or the Gap Scheme benefit if you’re a Gap Scheme provider) for inpatient services. 100% of cost for inpatient services. 100% of cost as a hospital out-patient or by a doctor or specialist in private practice anywhere in Australia. Bupa Medical Gap Scheme benefits apply to in-patient or same day patients only. Excess applies to in-patients only. Please note there is a small number of Network hospitals that may charge a fixed daily fee for some services. This fixed daily fee is capped at a maximum number of days for inpatient stays but is uncapped for day programs. Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. A small number of non PBS drugs are not covered — contact Bupa pharmacy advisor [email protected] 27 Effective APRIL 2014 NEW Bupa membership cards The following membership cards should be recognised at your hospital or practice. When HBA, MBF and Mutual Community became Bupa, members would have received one of these cards. However, some members may still present an HBA, MBF or Mutual Community card and some of these cards may contain obsolete product names. To provide our members with affordable health insurance, after becoming Bupa we generally did not send out additional new cards to reflect changes to product names. Refer within the guide for renamed products. As long as the membership number is current and the member is financial, the old cards will work. If members would like to order a new card they should contact us or log in to myBupa. 01 Jane Sample 02 Greg Sample 03 Audrey Sample 04 Brian Sample Membership number: 32528749 Member since: 2009 01 Jane Sample 02 Greg Sample 03 Audrey Sample 04 Brian Sample Top Hospital Cover Platinum Extras Membership number: 32528749 Member since: 2009 Ultimate Health Cover Pharmacy Saver NEW OSHC Bupa membership cards The following membership cards should be recognised at your hospital or practice. 01 Mario Garabaldi 02 Betty Garabaldi 01 Mario Garabaldi 02 Betty Garabaldi Student Number: 3082000 Education Faculty: University of Ballarat Membership number: 32528749 Overseas Student Health Cover Cover valid until 01/01/2013 Membership number: 32528749 Overseas Student Health Cover Cover valid until 01/01/2013 Please note: During 2014, Bupa will no longer be printing level of covers on membership cards. Bupa will not be reissuing any member cards, so from this date there will be a combination of Bupa cards with or without level of cover featured. 28 Effective APRIL 2014 Bupa INTERNATIONAL membership cards Bupa International members are covered by Bupa Australia hospital contracts. Bupa International health insurance Bupa Australia is part of the worldwide health and care specialists, BUPA. Bupa International provides health insurance to expatriates living and working in other countries, including Australia. Members with the following cards are covered by Bupa International: • Bupa Arabia • Bupa Hong Kong • Bupa Insurance Limited • Bupa Insurance Services Limited • Bupa Latin America • Bupa Thailand • IHI Bupa • Max Bupa • Sanitas (Bupa) Spain • USA Medical Services Corporation Bupa International offers the following products: • Bupa International Gold with dental • Bupa Worldwide Health options • Corporate bespoke plans • Company Gold Superior • IHHP (International Health Hospital Plan) • ISM (International Swiss Medical) • Lifeline Classic • Lifeline Essential • Lifeline Gold 29 Effective APRIL 2014 Bupa INTERNATIONAL membership cards The following international membership cards should be recognised at your hospital or practice. 30 Effective APRIL 2014 Pre-authorisation Hospital checks for Bupa International members A pre-authorisation hospital check for Bupa International members is required via fax or email with the form downloaded from the following website: www.bupa-intl.com/partner/medical-provider-network Alternatively you can call the Bupa International Helpline. Please see below for details. Whenever a patient requires day-case or inpatient treatment, please contact us as per the above with the following information: • Medical records • Symptoms • Diagnosis • Procedure • Admission and discharge date Contact information for Pre-Authorisation: Bupa International Tel: +44 1273 333911 Fax: +44 1273 866301 Email: [email protected] ihi Bupa Tel: +45 33 15 33 00 Fax: +45 33 32 25 60 Email: [email protected] Note: Helpline operates: 24 / 7 / 365 days a year For general enquiries to the Provider Services Department, they may be contacted via: [email protected] On receipt of the above information, the request will be reviewed and response given: • If requested by telephone: immediate response • If requested by email or fax: response within 72 hours Please note that in case of an emergency admission always contact the 24 hour helplines. Hospital Services for Bupa International Members Where a Bupa International member attends a Members First or Network Hospital/Day Facility for a service Covered under the Bupa Australia Agreement, the Bupa International member should be billed under the terms and conditions of the Bupa Australia Agreement. Hospital Claims for Bupa International Members should be sent to Hospital Claims, GPO Box 990, Adelaide, SA, 5001. If you need to pre-authorise treatment for a member of Bupa Latin America, please contact USA Medical Services on: Tel: +1 305 275 1500, for USA Tel: +1 800 726 1203, free of charge from USA 31 FOR MORE INFORMATION: Hospital use To ensure a timely response to your enquiry, please contact the correct department for assistance. Pre-Admission patient eligibility checks To verify a membership, hospitals can check Bupa Australia entitlement via the online eligibility system through Eclipse. This system is available 24/7. Membership Checking — https://eclipse.civica.com.au/ECFWeb If this system is unavailable due to system issues at Bupa Australia or Medicare then EMERGENCY checks can be done via telephone to Contact Centre on 134 135 (Current hours 8.00am to 8.00pm Mon to Fri, Sat 9.00am to 1.00pm EST). Post-Admission hospital claims enquiries Department: Hospital Claims Department For: Queries regarding a benefit received following hospitalisation Email: [email protected] Tel: 1300 663 590 Fax: 1300 303 548 Hours availability: 9.15am — 5.15pm, EST Monday to Friday Drs Rooms use For queries regarding payment of a medical claim please ring: 1300 367 877 Email: [email protected] Bupa Australia Pty Ltd ABN 81 000 057 590 Effective April 2014 10248-04-14P
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